Clinician's Corner - June 2017

Clinician's Corner| June 2017 EARLY VIEW

Globally, only 12% of the world’s population do not have access to a mobile phone, with rates of mobile phone ownership significantly higher amongst those with higher incomes, higher education levels and of younger ages. Significantly, however, rates of mobile phone ownership are increasing among disadvantaged groups in our society, indicative of a closing of the ‘digital’ divide across socio-demographic groups.

The last decade has seen a proliferation of mobile phone-based interventions for health and wellbeing, with thousands of mental health apps and other programs currently available. This means that, for the first time, the majority of people have access to a wide range of health and wellbeing support applications right in their pockets, accessible any time of the day or night. It is remarkable to note, though, that the majority of these programs have not been developed by health professionals, and even fewer have been evaluated.

In this context Crombie et al.'s report† on a feasibility study of a mobile phone-based intervention in disadvantaged men with alcohol use problems, available on Early View in Drug and Alcohol Review, is significant. ‘Disadvantaged men’, drawn from the most socioeconomically disadvantaged groups within general practices, unemployment centres, sports centres, bars and other community venues in Scotland, UK, are significantly more likely than their counterparts to develop alcohol use disorders and associated diseases. Prior to the Crombie et al. study, no previous evidence existed regarding the impact of brief alcohol-focused interventions among disadvantaged groups specifically, despite a large evidence base for their effectiveness in other groups. Following recruitment, participants were randomised to the mobile phone intervention or control. The mobile phone intervention comprised of 36 interactive text messages and images designed to increase motivation to reduce alcohol consumption via changing attitudes to alcohol use, modifying perceptions of social norms for drinking, and perceived behavioural control over alcohol use. The control group received 34 messages over the same time period on general health promotion topics, excluding alcohol use. The Early View article contains an Appendix of example messages send to intervention and control groups.

The recruitment target for this study was exceeded, indicating the potential appeal of the study and the intervention itself. Of the 67 male participants, aged 25-44 years, 96% were retained through to the study completion at 3 months’ post-baseline. Although the key aims of this feasibility study were to test the procedures, intervention and assessment acceptability, and other study facets ready for a larger randomised trial, inspection of the alcohol data provided by participants indicated both groups reduced episodic heavy drinking episodes over time, with slightly more benefits for men in the intervention group. The majority of men in the intervention group appeared to find the program worthwhile, and the level of engagement (measured in the form of replying to messages when requested) was also high (88% response rate).

This study adds to the growing evidence that mobile phones are an important, useful, and acceptable tool for people interested in addressing alcohol use problems. Clinicians are encouraged to source evidence-based mobile phone interventions to supplement their usual care, and potentially extend the reach of their clinical interventions, among people with alcohol use disorders.